Vascular Anaesthesia PDF
Preview Vascular Anaesthesia
OXFORD MEDICAL PUBLICATIONS Vascular Anaesthesia Oxford Specialist Handbooks published and forthcoming General Oxford Specialist Handbooks Oxford Specialist Handbooks A Resuscitation Room Guide in Oncology Addiction Medicine Practical Management of Complex Day Case Surgery Cancer Pain Perioperative Medicine, 2e Oxford Specialist Handbooks Pharmaceutical Medicine in Paediatrics Postoperative Complications, 2e Paediatric Dermatology Renal Transplantation Paediatric Endocrinology and Oxford Specialist Handbooks Diabetes in Anaesthesia Paediatric Gastroenterology, Anaesthesia for Medical and Surgical Hepatology, and Nutrition Emergencies Paediatric Haematology and Cardiac Anaesthesia Oncology Neuroanaesthesia Paediatric Intensive Care Obstetric Anaesthesia Paediatric Nephrology, 2e Ophthalmic Anaesthesia Paediatric Neurology, 2e Paediatric Anaesthesia Paediatric Radiology Regional Anaesthesia, Stimulation and Paediatric Respiratory Medicine Ultrasound Techniques Paediatric Rheumatology Thoracic Anaesthesia Oxford Specialist Handbooks Vascular Anaesthesia in Pain Medicine Oxford Specialist Handbooks Spinal Interventions in Pain in Cardiology Management Adult Congenital Heart Disease Oxford Specialist Handbooks Cardiac Catheterization and Coronary in Psychiatry Intervention Child and Adolescent Psychiatry Cardiac Electrophysiology and Catheter Forensic Psychiatry Ablation Old Age Psychiatry Cardiovascular Computed Tomography Cardiovascular Magnetic Resonance Oxford Specialist Handbooks Echocardiography, 2e in Radiology Fetal Cardiology Interventional Radiology Heart Failure Musculoskeletal Imaging Hypertension Pulmonary Imaging Inherited Cardiac Disease Thoracic Imaging Nuclear Cardiology Oxford Specialist Handbooks Pacemakers and ICDs in Surgery Pulmonary Hypertension Valvular Heart Disease Cardiothoracic Surgery, 2e Colorectal Surgery Oxford Specialist Handbooks Gastric and Oesophageal Surgery in Critical Care Hand Surgery Advanced Respiratory Critical Care Hepatopancreatobiliary Surgery Cardiothoracic Critical Care Neurosurgery Oxford Specialist Handbooks Operative Surgery, 2e in End of Life Care Oral and Maxillofacial Surgery Otolaryngology and Head and Neck End of Life Care in Cardiology Surgery End of Life Care in Dementia Paediatric Surgery End of Life Care in Nephrology Plastic and Reconstructive Surgery End of Life Care in Respiratory Disease Surgical Oncology End of Life in the Intensive Care Unit Urological Surgery Oxford Specialist Handbooks Vascular Surgery in Neurology Epilepsy Parkinson’s Disease and Other Movement Disorders Stroke Medicine Oxford Specialist Handbooks in Anaesthesia Vascular Anaesthesia Edited by Dr Jonathan P. Thompson Senior Lecturer in Anaesthesia and Critical Care Department of Cardiovascular Sciences University of Leicester and Honorary Consultant in Anaesthesia and Critical Care University Hospitals of Leicester NHS Trust Leicester UK Dr Simon J. Howell Senior Lecturer in Anaesthesia Biomedical and Clinical Sciences University of Leeds Leeds UK Dr Richard J. Telford Consultant Anaesthetist Royal Devon and Exeter Foundation NHS Trust Exeter UK 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 204 The moral rights of the authors have been asserted First edition published in 204 Impression: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 203940967 ISBN 978–0–9–959442–9 Printed in China by C&C Offset Printing Co. Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v Foreword Anaesthesia for vascular surgery is possibly one of the most challenging fields of our clinical practice. By virtue of their primary surgical pathology and its associated risk factors, patients have a very high incidence of co-morbidities, particularly hypertension, diabetes, cardiac, cerebrovascular, renal and respira- tory disease. Advances in anaesthesia must also keep abreast of surgical and graft developments which have led to a dramatic increase in the use of endo- vascular stents such that they now constitute the majority of surgery. In turn, however, this has resulted in the presentation of patients previously regarded as medically unsuitable for surgery since the perturbations of surgical trauma are markedly reduced. At the same time, open repair of aneurysmal and sten- otic disease is still an option for some and may be unavoidable for anatomical reasons in others. Patients with complex pathology may require hybrid proce- dures which entail an open surgical component in addition to graft placement. Further still, correction of graft complications and leaks may necessitate more complicated open surgery. Hence the traditional skills for handling clamping and unclamping of the aorta and major haemodynamic disturbance must be preserved. Perioperative organ protective is pivotal to optimising patient out- come. There is also a need to protect the kidney from ischaemia and contrast induced nephropathy, the spinal cord during open or endovascular aortic sur- gery, the brain in carotid surgery and the heart in all surgery. An understand- ing of appropriate monitoring of these organs, techniques for protection both pharmacologic and mechanical, appropriate use of anaesthetic and other drugs and amelioration of ischaemia-reperfusion injury is essential. Knowledge of regional anaesthesia, peripheral nerve blocks and sedation techniques is also important for anaesthesia and analgesia in many of these patients. A successful outcome is only as “strong as the weakest link” and both preoperative prepara- tion and postoperative care are integral facets. In negotiating all these aspects of patient care, vascular anaesthetists can truly be considered model periop- erative physicians. Recent developments in both surgery and perioperative care make this an apposite time to produce this handbook and the editors, all very expe- rienced and authoritative in this field, have collected an eclectic collection of clinicians to present a clear and easy to read overview of this challenging specialty. True to its status as a handbook, chapters are succinct, easy to read and search with appropriate use of bullet points and avoidance of verbosity. An excellent companion for the busy clinician both in training and those seasoned in practice. Professor Michael G. Irwin MB ChB MD DA FRCA FANZCA FHKAM Head, Dept of Anaesthesiology University of Hong Kong Chief of Service Queen Mary Hospital / HKU Shenzhen Hospital K424, Queen Mary Hospital Pokfulam Road Hong Kong vii Preface The management of the patient with vascular disease is evolving rapidly. Population screening for vascular disease has been introduced and its effects on practice are being evaluated. The management of associated medical conditions is also changing. New guidelines have been published for the management of acute coronary syndromes, stable coronary heart disease, diabetes, implantable pacemakers, and defibrillators. Decisions regarding surgical intervention and anaesthetic management remain complicated due to the co-existence of vascular disease at other sites or other co-morbid conditions, but have been aided by improved approaches to preopera- tive risk assessment, perioperative monitoring and postoperative care. Radiological expertise and procedures are increasingly used to treat condi- tions previously treated by open surgery, such as aortic aneurysms, occlu- sive lower limb arterial disease, or carotid disease. Priorities have evolved so that carotid endarterectomy is now performed as an urgent procedure after TIA or minor stroke. In addition, the pace of change over the last two decades has made it difficult for those involved in the care of the vascular surgical patient to remain updated with recent progress in perioperative management. The literature describes an increasing array of techniques for preoperative investigation and monitoring during anaesthesia, with dispa- rate evidence and recommendations. When faced in clinical practice with a patient with vascular disease, the anaesthetist needs to know what to do and when to do it, as well as what not to do and why. In this new addition to the Oxford Specialist Handbooks series we have tried to produce a concise volume that will enable the vascular practi- tioner (in its broadest sense) to adopt a practical, current, evidence-based approach to all aspects of perioperative care for the patient with vascular disease, particularly those undergoing interventional radiological, diagnos- tic, and surgical procedures. Although primarily aimed at anaesthetists, we hope the book will be relevant to vascular nurses, theatre practitioners, trainees in Intensive Care Medicine and possibly even vascular surgeons. Our approach has been to combine essential background knowledge with useful, clinically relevant sections on management, so the book can be used to enhance awareness of potential problems, as an aid to revision, but also as a practical ‘How to do it’ guide for patient management. The book is divided into sections and starts with what we consider essential details on the epidemiology of vascular disease, followed by rel- evant anatomy and pathophysiology. Good preoperative evaluation is vital to a successful outcome, but the vascular anaesthetist must also be aware of the processes involved in complex surgical decision-making; these are detailed together. Current approaches to risk assessment and risk reduction are emphasized, including advice on how to set up and run a preoperative assessment clinic. In the sections on medical management of common co- existing diseases, monitoring, practical procedures and common regional anaesthetic techniques, we have tried to summarize what the practitioner needs to know for everyday practice, based on the most recent data. viii PREFACE Radiologists are taking an ever greater role in the care of the vascular patient; this can be a difficult and complex area of practice and we have deliberately included a section dedicated to radiological management. The final three sections are intended to be a convenient guide to the manage- ment of different vascular procedures and complications during and after surgery. They are intended to be used as an ‘aide-memoire’ for periopera- tive care and include guidance on the management of common postopera- tive problems. The contributors are all experienced clinicians actively caring for patients with vascular diseases. They are predominantly consultant anaesthetists with a special interest in vascular anaesthesia, but include vascular surgeons, radiologists, cardiologists and other physicians. We hope this book will fulfil its aims and be useful, relevant and helpful in the day-to-day management of the vascular surgical patient. Jonathan P. Thompson Simon J. Howell Richard J. Telford March 203 ix Contents Symbols and Abbreviations x Contributors xx Epidemiology of vascular disease 2 Anatomy physiology and responses to vascular surgery 25 3 Evaluation of the vascular surgical patient 85 4 Management of specific medical conditions and medications 59 5 Principles of perioperative care 22 6 Practical procedures, regional anaesthesia, and pain management in vascular surgery 25 7 Monitoring of the vascular patient 3 8 Anaesthesia for vascular radiology 333 9 Management of patients undergoing specific elective vascular procedures 349 0 Emergencies in vascular surgery 447 Post-operative management 467 Index 525
Description:The list of books you might like
